AIM:To construct key quality indicators for aged care facilities in China.BACKGROUND:Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China.DESIGN AND METHOD:This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines.RESULTS:The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively).CONCLUSIONS:Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement.RELEVANCE TO CLINICAL PRACTICE:Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities.ELDERLY OR PUBLIC CONTRIBUTION:No elderly or public contribution.

AIMS AND OBJECTIVES:To investigate the use of physical restraints in aged care facilities(ACFs)and analyse its associated risk factors.BACKGROUND:Physical restraints have been widely used in ACFs worldwide, but they can cause physical and mental harm to older people. It is important to regulate the use of physical restraint.DESIGN:A cross-sectional observational and correlational multicentre study.METHODS:By convenience sampling method, we selected eight ACFs in four representative regions of Hunan province, China, for this study. The ACF-related information was obtained by interviewing the managers and reviewing records. We conducted investigation and observation on the elderly in the ACFs to understand the use of physical restraints at three different times: 9:30-11:30, 16:00-18:00 and 19:30-21:30 on a working day. The STROBE checklist was followed for this cross-sectional study.RESULTS:This study found that the utilisation rate of physical restraints was 23.2%. The critical risk factors affecting the use of physical restrains include the following: (1) the ratio of nursing staff to the elderly residents; (2)whether there is a dementia care unit at the facility; (3) the number of elderly residents in each room; (4) the elderly residents' age, degree of education, marital status, care dependence and cognitive impairment; (5) whether the elderly has suffered from a stroke or senile dementia; (6) whether the elderly carries medical catheters.CONCLUSION:There is a lack of standardisation in the use of physical restraints in ACFs of central China. Chinese ACFs should develop guidelines and reduction measures to standardise the use of physical restraints, basing on the key factors affecting the use of physical restraints.RELEVANCE TO CLINICAL PRACTICE:The use of physical restraints in ACFs is threatening the safety of the elderly residents. Understanding the implementation of physical restraint in ACFs can provide reference for reducing the use of physical restraint.

目的 探讨湖南省民办养老机构老年人身体约束使用现状及其影响因素,为规范我国民办养老机构老年人身体约束提供参考.方法 采用分层整群随机抽样的方法抽取湖南省3个区域内6家民办养老机构内814名老年人作为研究对象,应用养老机构老年人身体约束使用现状调查表、日常活动能力评定量表和简易精神状态评价量表进行调查.结果 湖南省民办养老机构身体约束使用率为23.8％,19:30-21:30使用身体约束的频次最高(占51.6％),身体约束实施的常用部位为双上肢(占36.4％),最常见体位为仰卧位(占48.2％),常用的工具为约束带(占51.8％％);身体约束使用前均征得了老年人或其家属的同意,但无约束使用相关记录.回归分析结果显示,养老机构是否有痴呆单元、护理人员与老年人比、老年人的年龄、文化程度、是否患有老年痴呆、日常活动能力、认知功能、有无胃管、有无导尿管、有无静脉留置针是身体约束使用的主要影响因素(均P＜0.05).结论 湖南省民办养老机构身体约束使用率较高,并且存在诸多使用不规范的情况,养老机构和相关管理部门需根据约束使用现状和影响因素制定更多的措施,以减少和规范我国民办养老机构身体约束使用.

综述养老机构老年人身体约束和跌倒的研究进展,从高跌倒风险会增加老年人身体约束的使用、使用身体约束会增加跌倒的发生风险、减少或解除身体约束以及实施身体约束替代措施会减少跌倒的发生3个方面进行阐述,为养老机构最大限度减少身体约束提供参考.

目的:基于CIRO培训评估模型构建继续护理学教育效果评价指标体系,以期为评价继续护理学教育效果提供科学、全面、可靠的工具.方法:以CIRO培训评估模型为框架,在文献回顾、半结构式访谈及小组讨论的基础上制定指标体系初稿,并编制完成专家函询问卷,采用德尔菲专家咨询法对17位专家进行2轮咨询,运用层次分析法明确各指标权重,并最终确定基于CIRO培训评估模型的继续护理学教育效果评价指标体系内容及各指标权重.结果:2轮函询问卷的有效回收率分别为100.0％和94.1％,专家权威系数分别为0.880,0.889,肯德尔和谐系数分别为0.423,0.576,差异具有统计学意义(P<0.01).最终形成的评价指标体系包括4项一级指标、12项二级指标和43项三级指标,其中背景评估包括2个二级指标和7个三级指标;输入评估包括4个二级指标及13个三级指标;反应评估包括4个二级指标及15个三级指标;输出评估包括2个二级指标及8个三级指标.结论:基于CIRO培训评估模型构建的继续护理学教育效果评价指标体系具有较好的科学性和可靠性,可为继续护理学教育效果评价及持续改进提供依据.